HomeFeaturesAn Expert’s Guide: Life as a Pediatric NP

An Expert’s Guide: Life as a Pediatric NP

“It’s an exciting field. There’s so much you can do. And it’s amazing to take care of someone from the time when they’re little, and then get an invitation to their high school graduation.”

Stacia M. Hays, DNP, Clinical Associate Professor, Baylor University Louise Herrington School of Nursing

Pediatrics is the oldest and largest specialty practice area for nurse practitioners (NPs). In fact, the very first NP program, developed by Dr. Loretta Ford and Dr. Henry Silver at the University of Colorado in 1965, was a pediatric nurse practitioner (PNP) program focused on meeting the needs of the pediatric community.

PNPs and pediatric-focused advanced practice registered nurses (APRNs) offer low-cost, high-quality care to children from birth to the transition to adult care. Over the last 56 years, they’ve become an essential component of the healthcare workforce, providing a wide spectrum of healthcare services in primary, hospital, outpatient, and specialty care settings. And as with other NP specializations, PNPs are more likely than their physician counterparts to practice in rural and underserved areas.

Healthy children have a better chance of becoming healthier adults and pediatric NPs are on the front lines of building a healthier future. But challenges remain: antiquated laws in some states restrict a PNP’s ability to practice to the full extent of their training; public funding for pediatric care falls short of the funding for adult care; and the nation is facing a shortage of pediatric providers, especially in rural and underserved areas.

While pediatrics may be the oldest NP specialty area, it’s also one of the most advanced. Today’s PNPs are helping mature the role, and are engaged in research and advocacy that’s changing the landscape of pediatrics itself.

To learn more about the work, advocacy, and future of pediatric NPs, read on.

Meet the Experts: Dr. Stacia Hays and Dr. Jeremy Jordan

Stacia M. Hays, DNP, APRN, CPNP, CCTC, CNE, FAANP

Dr. Stacia M. Hays is associate dean for the online graduate program and clinical associate professor for the Baylor University Louise Herrington School of Nursing. She is also a board-certified Pediatric Nurse Practitioner with an active pediatric practice. She is a current Primary Care Editor for the Journal of Pediatric Health Care, and holds national certifications as a Nurse Educator, Clinical Transplant Coordinator, as well as a Certificate in Public Health.

Dr. Hays has extensive leadership with institutional Quality Improvement initiatives and project development. Her teaching is informed by her clinical, leadership, and institutional experiences while incorporating a variety of educational modalities. Internationally, she has been involved in developing a credentialing process for advanced practice nursing in Brazil. Dr. Hays is a recognized advocate for NPs and has received national and international advocacy awards, and is the current treasurer of the National Association of Pediatric Nurse Practitioners (NAPNAP).

Dr. Hays was interviewed for this feature in the summer of 2021.

Jeremy Jordan, PhD, CRNP, CPNP-AC, CCRN, CNE

Dr. Jeremy Jordan is an executive board member at large at the National Association of Pediatric Nurse Practitioners (NAPNAP). He is also an assistant professor and coordinator of the acute care PNP specialty track at the University of Alabama at Birmingham and a practicing PNP in the Pediatric ICU at Children’s of Alabama. He has more than 12 years of experience as a clinician, educator, and researcher.

In addition to teaching and clinical practice, Dr. Jordan conducts research on the prevention, diagnosis, and management of pediatric neurologic injury. He has served as co-chair of the Acute SIG and as a member of the inaugural DEI Committee of NAPNAP.

Dr. Jordan was interviewed for an update to this feature in the summer of 2024.

The Evolution of the Pediatric NP Role

“The PNP role has evolved as times have changed and as the needs of children have changed,” Dr. Hays says. “But the PNP role continues to be dedicated to advancing children’s health, and it’s built from a public health perspective. We never lost our roots.”

The roots of the modern PNP date back to Dr. Ford and Dr. Silver’s first PNP program in 1965, which was started to provide increased healthcare to children in urban and rural areas. And those roots are intertwined with the core principles of nursing, which include a holistic, prevention-focused approach. Today, holistic care and increased healthcare access are two of the major narratives that reach across all healthcare professions, and they’re baked into a PNP’s DNA.

“One of the interesting things about PNPs is we’ve always been on the forefront of understanding social determinants of health and their impact on child outcomes,” Dr. Hays says. “It’s exciting to now see those things become more of a national focus, with research dollars and education being supported for it.”

Today, PNPs can own their own practices and provide care in all areas of child health and wellness, from primary care outpatient clinics to subspecialty clinics like cardiology and oncology. They work in hospital settings, neonatal and pediatric ICUs, emergency departments, and academic institutions. PNPs participate in and lead multidisciplinary teams through both research and practice. And increasingly, they’re building bridges between primary care and mental health in pediatrics.

Unique Aspects of the Pediatric NP Role

Adult care is often predicated upon the idea that the patient will comply with what a practitioner tells them to do. But with children and teenagers, it’s rarely so simple. The fact that a pediatric patient might not be as forthcoming about their condition as an adult—either intentionally or unintentionally—creates an added layer of detective work.

“You have to be creative, and you have to be flexible,” Dr. Hays says. “There are textbook approaches to doing an examination, for example, but kids might have a different idea about the way that needs to be done.”

Treating teenagers can also require some extra homework. PNPs with teenage patients need to be cognizant of how the cultural landscape intersects with public health, such as in the dangers of e-cigarettes and designer drugs or the behavioral impacts of new social media trends. And in some cases, simply being cognizant of those factors isn’t enough: PNPs may need to demonstrate a little street smarts in earning their young patients’ trust, and balance a respect for their privacy while still prioritizing their health.

“Adolescents are keen on trying to figure out if you’re really part of the group, and really on their side,” Dr. Hays says. “They want to make sure you have the credibility to have a conversation with them. But the evolution of all these new trends for teens can be challenging because just when you get one down, you have to try to figure out the next latest craze.”

The Advocacy Efforts of Pediatric NPs

Pediatric NPs are staunch advocates for children and their families. Together with the National Association of Pediatric Nurse Practitioners (NAPNAP), they’ve developed initiatives and partnered with organizations to help identify and combat child and human trafficking. NAPNAP is also a powerful voice in the fight to expand healthcare access to underinsured and uninsured children.

“Children under 18 make up approximately 22 percent of the population,” Dr. Hays says. “But less than 1 percent of federal funding for hospitals goes to children’s hospitals. We spend so much money and time trying to educate adults on preventive care, but we’re forgetting that in the child population. Healthy children lead to healthy adults.”

To advocate for children and their families, PNPs also need to advocate for their profession: in several states, restrictions prevent NPs from practicing to the full extent of their training.

“The fight for full practice authority continues to be a big issue,” Dr. Hays says. “This inability to practice at the top of our training, education, and scope of practice is really limiting care. It’s important for PNPs to get involved legislatively, not only at the state level but at the federal level with policy development and evaluation, so that we can impact care at the point of origin as well as in our own practice.”

Restrictions on NP practice can negatively affect health outcomes in many ways. Supervisory requirements around the prescription of certain medications, such as those used in the treatment of ADHD, anxiety, and depression, can act as a barrier to children getting the help they need in an expedient manner. In other instances, the need for physician approval and supervision can diminish a PNP’s ability to provide comprehensive care in an otherwise underserved area.

Things are starting to change. Today, 30 states and territories in the US have enacted a form of full practice authority for their NPs. In those 30 states and territories, it was NPs themselves who were the primary agents of change. If more states are to follow, more grassroots advocacy from NPs is needed.

The Future for Pediatric NPs

The future for PNPs contains both challenges and opportunities. In addition to securing more funding for children’s health and increasing access to children’s healthcare, one key challenge is smoothing the transition from pediatric care to adult care. That transition is particularly important for children with special healthcare needs, who are at increased risk for chronic, physical, developmental, behavioral, and/or emotional conditions. According to the Agency for Healthcare Research and Quality (AHRQ), a lack of clarity in the transition from pediatric to adult care can lead to gaps in care and adverse health outcomes. Got Transition, a federally funded resource center on healthcare transition, aims to improve the process.

“I’d love to see more adult healthcare providers, as well as pediatric providers, working together in building bridges so that kids can transition more smoothly,” Dr. Hays says.

As the PNP role continues to evolve, PNPs will continue to be involved in cutting-edge research which can, in turn, inform policy. PNPs are already involved in research into genomics and forms of gene therapy, and they’ll continue to translate bench-side science into bedside practice. PNPs will also be involved in quality improvement research in the office or practice setting. And major opportunities for increasing children’s healthcare access can be realized through further integration with school boards and schools.

“I think every school board should have a pediatric-focused nurse, someone who really gets what children need, and is able to meld developmental needs and healthcare needs,” Dr. Hays says. “Kids spend so much time in school, and they have illnesses that need to be addressed.”

For all the changes that the PNP role has seen in the last 59 years, its core principles have remained and will remain the same. This is an evidence-based, holistically-minded specialty with a focus on improving public health. And, just like the initial PNP program at the University of Colorado, the modern PNP role remains deeply rooted in the idea of community.

“It’s an exciting field,” Dr. Hays says. “There’s so much you can do. And it’s amazing to take care of someone from the time when they’re little, and then get an invitation to their high school graduation.”

Update 2024: Trust & Distrust in the Post-Covid Era

NPs across the nation played a crucial role in the response to Covid-19, with most states introducing waivers that eased restrictions and oversight on NP practice to better address the public health emergency. As a result, many restricted and reduced practice states got a test run of full practice authority. The test run was a resounding success.

“There is a little more momentum towards full practice authority in states that otherwise wouldn’t have pushed for it, because we have additional real time information to show that NPs don’t need that extra level of oversight in order to provide high-quality care,” Dr. Jordan says.

Unfortunately, some states have rolled back those Covid-era waivers. In those states, full practice authority for NPs remains a major advocacy issue, one that takes up significant bandwidth. Meanwhile, states that do have full practice authority are not only better able to care for their patients, but also able to extend their advocacy into important, patient-centered areas.

As members of the nation’s most trusted profession, NPs also have a leading role in combating misinformation and incorrect information. While that’s always been part of the job, it’s taken on new significance in a highly politicized social media climate.

“Even before the pandemic, we spent a lot of extra time talking about the importance of vaccines,” Dr. Jordan says. Now, there are additional aspects, like gender-affirming care, vaping, even gun safety and reproductive health, where we’re having to spend much more time combatting incorrect medical information. What some families are hearing from news, social media, and politicians is not based in science at all.”

NPs pride themselves on being able to spend extra time with their patients. But their time is not infinite. And addressing the glut of medical misinformation patients and their families encounter online means less time spent on summer safety, the dangers of vaping, and other general developmental issues. But the PNP’s position is unique. They’re able to earn trust with families and patients over years. This isn’t arguing over the internet—it’s having real conversations with real families.

“It may mean we have to stay late or come in early in order to do our charting or whatever it may be,” Dr. Jordan says. “But we know the importance of spending that time with our patients and their families and getting them the right information and the right resources.”

For how much it’s accomplished, it can be hard to remember that this is still a relatively young profession and one that’s still developing. Going forward, the PNP role will continue to grow in sophistication and maturation. Led by organizations like NAPNAP, PNPs will extend their advocacy into more areas of public health and community outreach. This may be a young profession, but it recognizes its youth as an asset: one that’s nimble, flexible, and able to adapt to the needs of their patients.

“I see PNPs continuing to grow our bedside skill and our ability to practice independently, but I also have seen the role move beyond just the bedside,” Dr. Jordan says. “We’re seeing more and more PNPs in leadership positions within health systems. We’re seeing more PNPs conducting really important research to improve the care of children. The future of pediatric advanced practice nursing is bright.”

Resources for Pediatric NPs

Pediatrics is the oldest and largest specialty practice area for NPs. To learn more about the role of the PNP today and to see where it’s going, check out the resources below.

National Association of Pediatric Nurse Practitioners (NAPNAP): With over 8,000 members, NAPNAP is the professional organization for PNPs and all pediatric-focused APRNs. Established in 1973, it is the oldest professional society for NPs and remains the only national organization dedicated to both advancing the APRN role and improving the quality of health care for infants, children, and adolescents.
Journal of Pediatric Healthcare: The official journal of NAPNAP, the Journal of Pediatric Healthcare provides up-to-date clinical information and research findings regarding primary, acute, and specialty healthcare for children of newborn age through young adulthood within a family-centered context.
American Association of Nurse Practitioners (AANP): With over 118,000 members, AANP is the leading voice of the nurse practitioner profession and a powerful advocate for both NPs and their patients.

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.